Designing Care Management Entities for Youth with Complex Behavioral Health Needs

Although CMEs were developed specifically to serve youth with complex behavioral health needs, the concept is rooted in the broader historical transition from residential care to community-based care for individuals with complex health needs, typically individuals with serious and persistent mental illness or developmental disabilities.^{10, 25, 37}

 In 1984, the National Institute of Mental Health within the U.S. Department of Health and Human Services initiated the Child and Adolescent Service System Program (CASSP).²⁵ The program provided funding and assistance to all States to increase interagency collaboration around providing services for youth with complex behavioral health needs. A few years later, Congress mandated that States develop plans for serving adults and youth in the community, as opposed to those in residential settings. From that time on, a wave of congressional mandates and programs, as well as foundation-funded initiatives, have encouraged interagency collaboration and spurred the creation of community-based models for serving individuals with complex needs.²⁵

CMEs were developed to serve youth whose needs were not met by traditional managed care organizations or organizations providing adult home- and community-based services, both of which lack experience in cross-agency service coordination.^{9, 25, 38, 39} Early CME efforts provided the building blocks for the CHIPRA quality demonstration projects described in this document.